Childhood, Health and Education Reflections

Thursday, February 2, 2012

After a hot morning at the S.t Joseph Nansana Catholic
School, a primary school in the suburbs of Kampala, followed by a site tour of
an education- and health-focused NGO based in Nansana, called “Nurture Africa”,
exhaustion overruled our group’s ability and willingness to actively engage in
discussion. Even the vanilla ice cream
bought at our roadside stop that reminded many Hopkins students of Betty
Crocker Vanilla Frosting, and was deliciously cold hadn’t helped much.

While our trio’s focus for the trip was on education, we had
planned for a rather academic reflection session with our peers. Looking at the tired faces, and back at each
other, we knew we’d pull this through.

While in Uganda, we had predominantly focused on the
disparities between public and private schools, at both the primary and
secondary levels. Specifically, we had
looked at the effects of Universal Primary Education (UPE) and Universal
Secondary Education (USE), policies with the goal of providing free primary and
secondary education to children in Uganda.
Furthermore, our time in Uganda had coincided with the release of PLE
results, the marks on the national Primary Leaving Examination, that likely
cemented the fate of many young minds.
The exams and results had served as a great backdrop to our lively
discussions that settled around the inequity between public and private
schools, and had highlighted educational patterns similar not across Uganda and
in the US, but maybe across the World.
While entertaining these similarities, we had begun forming a draft for
our reflection.

When planning four our reflection session, and throughout
the trip, the diversity of our trio played an essential role in steering
conversation. Amongst the three of us,
we had attended both public and private schools in a total of six different
countries: Switzerland, Germany, Uganda, Ivory Coast, and the USA. Through our own experiences, our group
discussions, and our experiences during structured activities in Uganda, we
realized just how much we had in common, and what a large role misconceptions,
especially in regards to education could have.
With this in mind, we began our reflection session.

While the fatigue was still visible in our peer’s faces
while we questioned them about their academic past, we did find out some
interesting facts about our group:

- Most JHU students attended public secondary schools; most
Makerere students attended private secondary schools.

- JHU students generally defined their scholastic experience
by social experiences, Makerere students by academic rigor.

- For most students, at least one parent had previously
attended university. (The three students whose parents both had not attended
university were all from Hopkins)

- When inquiring about student’s perception of their secondary
education system’s fairness (predominantly in regards to gender), we got mixed,
but overall relatively positive answers from both Makerere and Hopkins students.

- The majority of students, Makerere and Hopkins alike, perceived
their secondary education as extremely helpful and beneficial in their
development. (Three students felt that their social experiences and
environments, especially at the university level, were more impactful in their
development)

- While parental involvement varied from person to person
regardless of origin, all students acknowledged that parental value of
education is a critical factor in educational achievement.

- Given enough money and the choice of sending their
children to either a public or private school of similar academic reputation, most
students, from both universities, would send their child to the same type of
secondary school they attended (ie. If they attended private school, they would
send their child to private school and vice versa)

To conclude our reflection session, we handed out pieces of
paper with two questions:

1) Public school students: How would you describe a private
school?

Private school
students: How would you describe a public school?

2) If you could only send one of your children to school,
would you send your son or your daughter?

While public school students (predominantly American)
described public schools as “snotty”, “prestige”, “elitist”, “having better
teachers and academics”, “affluent” and “sheltered”, their public school attending
counterparts (mostly Ugandan) described private schools as “congested”,
“underequipped”, “”having limited options”, “full of inequality”, and
“diverse”. As discussed as a group after
reading out the results, we realized that both public and private students had
a largely negative opinion about the opposite type of school.

While our discussion was cut short by our speaker, a head
teacher from Kampala entering the room for our talk, our trio was pleasantly
surprised to note that, when faced with the choice of only sending one, the
majority (63%) of our group would send their daughter, rather than their son to
school. This ended our day on a rather
optimistic note, especially after weeks of reading and hearing about the high
drop-our rate of girls in Uganda.

Sunday, January 29, 2012

On the evening before the final academic presentations at the Makerere University School of Public Health, we led a discussion on Ugandan and American perceptions of fertility, relationships, love and maternal health. We also sought to engage a broader culminating discussion to provide a sense of closure on the last Sunday at Ndere Center in Kampala. We sensed a slightly more somber mood: the days of independent fieldwork had come to a close and groups were mentally gearing up to articulate in fifteen brief minutes the very complex experiences and issues they had encountered over three weeks in Kampala and Rakai.

Our first goal was to rekindle some of the energy and dynamism that has characterized so much of this trip. We held two simple physical games, both requiring closeness and non-verbal communication. We wanted to harness some of the palpable restless energy, and the games did restore a sense of spirit, even after we had gorged ourselves on soup, Luwambo and all the classics — matoke, rice, yams, Irish potatoes, beans, etc. The competitive element allowed people to refocus after a minimally structured day in Kampala, first challenging three bodies to fit on a two-foot square leaf of newspaper, and then rearranging groups along a line without speaking.

Rather than structure a didactic conversation on the nature and scope of maternal health issues in Uganda, we opted to sensitize the group to the diversity of our own experiences (i.e. number of siblings, aunts/uncles, one's birth location, and anticipated number of children). Interestingly, we did not find a stark delineation between Hopkins and Makerere students. For instance, of the two people who reported having been born in a maternity center, one was American and the other Ugandan. The only universal perception was that of a uniquely rewarding MU-JHU collaboration, which students described as successful due to the group's cohesion, dynamism, openness, and diversity. Many cited preexisting anxieties that the group might gradually fragment into numerous cliques, but such a scenario never materialized in Uganda. Instead, the group was notable for its absence of "weird group dynamics", as well as its acceptance and receptiveness to individuals' needs.

The Social Context for Maternal Health in Africa
Social dynamics and relationship norms provide a contextual landscape for maternal health, both in terms of a woman's access to care and her health outcomes. We wanted to gauge whether the American and Ugandan students had encountered any surprising dynamics or behaviors, at the rural home-stay or in urban Kampala, that had informed their understanding of relationship norms (either American or Ugandan). Patience (MU) noted the seemingly inseparable nature of romantic relationships between Americans. She described love as pervasive and passionate, specifically noting the long distances over which relationships played out. She also noted, however, that divergences in academic or career paths were often enough sever ties between young couples. Both of her observations provide insight into how Ugandans might perceive American relationships.

The Americans were struck by the affection, generosity and intensity of platonic relationships between Ugandans. Jacques described contrasts between Ugandan and American social norms, noting that Americans are rhetorically "progressive," but in fact "very guarded about our space." In contrast, Ugandans more openly hug, hold hands and tolerate temporarily close quarters, on public taxis or Kampala's streets. Paradoxically, public displays of romantic love are rare and widely construed as inappropriate. As one MU student put it, "We don't have a kissing culture." The American students appreciated Ugandans' heightened sensitivity to physical well being and aberrations of the body. A bandaged knee, unnoticed in the U.S., had elicited Ugandans' concern (Joyce). Similarly, a conductor on a taxi had repeatedly asked Henry whether he was comfortable in the cramped space. The general mood of empathetic concern is perhaps best encapsulated by the typical Ugandan opening question in conversation: "How is your life?"

American and Ugandan Experiences: Birth and Fertility
Both MU and JHU students documented lower fertility rates among their generations, relative to their parents'. Of course, our results are not necessarily applicable to Uganda as a whole, for we were working with a highly educated group of students attending Makerere University. Nonetheless, these data do give a rough portrait of changes in contemporary reproductive norms across the life course and generations. Most students had 3-5 maternal aunts/uncles (45%), and roughly equal numbers had 1-2 (26%) and >6 maternal aunts/uncles (30%). The proportions of students reporting 1-2, 3-5 and >6 paternal aunts/uncles were roughly equal (~33%). The majority of students had 1-2 siblings (65%), with five students reporting 3-5 siblings. With respect to future fertility, most envisioned having 1-2 (48%) or 3-5 (39%) children. Of the three students who desired >6 children, all were Ugandan.

Adelina observed a qualitative correlation between a student's number of siblings and desirable future fertility rates. Henry noticed less of a contrast between Ugandans and Americans than the literature might lead us to anticipate. Indeed, we found some flexibility and variability in perceptions of the appropriate family size, and never encountered unrelenting perceptions of "normality" in fertility.

We also posed questions related to anticipated choice of delivery site for expectant American and Ugandan mothers. Americans generally believed that Ugandans gave birth at home, citing barriers such as transportation and cost of hospitalization, as well as cultural norms, perceptions of safety, and limited education as determinants of home birth. Brynn recollected a lecture by Gilbert Burnham, in which he mentioned that the majority of Ugandans live in secluded rural areas. Frank proposed that more Ugandan women might give birth in the presence of a traditional birthing attendant (TBA), due to lower cost and proximity to the village. In contrast, Ugandan students assumed that Americans gave birth in hospital settings, as access to health care was perceived to be high. Interestingly, Patience expected technology to be "so high" in the U.S. that some women might give birth in their own kitchens.

In fact, 83% of all (Ugandan and American) students had been born in a hospital, potentially reflective of the prominence of health facilities in the course of pregnancy and delivery in both countries. Only one Ugandan student had been born at home. This finding might offer an interesting starting point for further discussion related to the medicalization of childbirth, both in the U.S. and Uganda.

In Kampala with No Agenda
During reflections on the free day spent in Kampala, students echoed earlier positive impressions of the group dynamic as whole. The MU students relished in seeing JHU students respond to taxis, crowds and vendors on the streets. MU students also felt directly responsible for the experience of their American counterparts. JHU students sensed and appreciated the generosity and patience of their MU counterparts, and benefited from their guidance and the opportunity to independently explore the city. There was a general consensus that MU students would benefit from a future program in Baltimore, and that it would enable the Americans to reciprocate in some small way. Marie alluded to potential parallels between Baltimore and Uganda in terms of health and education. Adelina emphasized the necessity of experiential learning to good global health practice, and reasserted the need for travel and direct interactions between students in developing countries and the developed world. The desire to integrate Ugandan hospitality, work ethic and resilience into our lives in the U.S. was reiterated. For many, this program has revealed or reconfirmed academic and career paths, and that process has continually drawn from the invaluable aid (linguistic, cultural and social) of our Makerere collaborators.

The true extent of the program's impact on our spiritual, service and professional lives will reveal itself only gradually. But individual growth is also already evident. The candid nature of our discussions has enabled us to break through superficial impressions of place and people to tease out motivations, interests, and structural factors that influence health outcomes. I am hopeful that the group dynamics we cultivated were not the result of some arbitrary collection of complementary personalites, but rather the result of purposeful conversation, openness and engagement, qualities that can be replicated with future groups in Uganda, Africa, and throughout the world.

Saturday, January 28, 2012

We arrived at Dulles about 3:30 and had everyone dropped off at Mason Hall about 6. Thanks to all the students for being such a wonderful group! A few more blog posts, and probably many more pictures, to follow soon.

During our reflection session, we decided to present open-ended questions to the group and probe deeper into their responses. We discussed the first night in the rural homestay, both positives and negatives. We also conversed about ethical or proper behavior issues such as responding to "too much food." We ended the open-ended response session with statements from many students about their goals and expectations during their homestay. We tied up "loose ends" by discussing fears to overcome as part of the experience.

"Too much food" was a common statement brought up during the session. The homestay families showered their generosity among the students by providing them with large meals, abundant with all kinds of foods. Numerous students in the discussion exclaimed that they felt bad for refusing food and that "it was so much." THe students from Makerere University chimed in, claiming that a cultural rule in Uganda in terms of being a guest was to never refuse food. They claimed that refusing food was considered downright rude.

Some students in the discussion session expressed fears about surviving the homestay as well as fitting in with the family. There was a general vibe that the students were still getting used to living in a rural homestay. A few students from Makerere University shared comments about how hilarious it was for them to watch when JHU students adjust or behave. The method of "basin showering" was a common cited new experience for many of the JHU students during the rural homestay.